Abstract

Background: Ulcerative colitis is thought to arise from an aberrant immune response to a change in colonic environment in a genetically susceptible individual. Steroid dependant cases pose a significant challenge to clinicians. Fecal microbiota transplantation (FMT) has emerged as a novel approach to alter the colonic microbiome and has a promising future in emerging as a successfully treatment modality.

Methods: This observational study was conducted at the outpatient, indoor patients of Gastroenterology Department of DMC&H, Ludhiana. Two young healthy unrelated donors were screened with their 16 sRNA microbiome profiling done and subsequently enrolled. Fifteen patients suffering from ulcerative colitis (steroid dependant) were enrolled for the study. FMT was given twice a week for 1 month followed by once a week for 5 months with total duration of 6 months. Outcome was assessed at 4 months and 1 year follow-up according to rate of clinical response, remission and endoscopic remission. Safety and adverse effects were also recorded.

Results: Out of the 15 (100%) patients enrolled, mean age was 34.60+9.33 years (23–55) and there were 8 (53.3%) males. FMT therapy induced clinical remission in 73.3% at 4 months and in 93.3% patients at 1 year of follow-up. Clinical response was seen in all 15 (100%) patients at 4 months and 1 year follow-up. Endoscopic remission was in 26.7% patients at 4 month and in 73.3% at 1 year follow-up. There were no major side effects observed during the study.

Conclusions: FMT is effective in inducing clinical response, clinical remission and endoscopic remission in patients of steroid dependent ulcerative colitis. In view of toxicity profile of biological and steroids, it seems to have a promising future in the new era of clinical practice.